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Acute Otitis media (AOM) is one of the most common paediatric infectious diseases. The clinical spectrum may extend from a benign, self-limiting condition to a prolonged and sometimes complicated disease. Although in industrialised countries serious complications are rare, the burden of AOM is large, with impaired quality of life and high direct and indirect socio-economic costs. First described by Hippocrates in 450 BC, this disease continues to present one of the more troublesome medical problems of infancy and childhood.

Otitis media with effusion (OME or “glue ear”) is the most common cause of hearing impairment in childhood. The condition is generally self-limiting, but may occur during a period when poor hearing will impede speech and language development. The effects are mostly short term, but in children in whom the condition recurs throughout childhood, some effects on behaviour and cognition are detectable up to the age of 10 years and beyond (Bennett and Haggard 1999).

Chronic otitis media is defined as chronic inflammation of the mucosa and submucosa of the middle ear. Chronic otitis media is recognised to be part of a continuum of inflammatory middle ear disease that also includes acute otitis media and otitis media with effusion.

This chapter will deal with the use of bone-anchored hearing aids (BAHAs) and will also cover Softband, a non-surgical application of the hearing aid part of BAHA in certain situations.

Cochlear implantation is now a mainstream option for the management of children with severe-to-profound hearing loss. Worldwide, approximately 65,000 people have cochlear implants, of whom approximately 25,000 are children. Cochlear implants are suitable for children from the 1st year of life onwards. Current research indicates that among congenitally deafened children, those who are implanted at a very young age seem to have the best outcomes from cochlear implantation. With the implementation of universal neonatal hearing screening (UNHS) in many developed countries and with the ability to obtain objective, frequency-specific and earspecific hearing thresholds using auditory brainstem responses (ABR) and auditory steady state responses (ASSR) at, or shortly following birth, it is no longer necessary to delay intervention until the child is able to perform conventional behavioural tests. Yoshinaga-Itano et al. (1998) published seminal research that demonstrated that children who were identified with hearing loss early, and provided with amplification or implantation soon afterwards, were able to achieve much better outcomes in speech and language development than children whose hearing loss was identified later or who had delayed intervention.

Dizziness is a lay term used to describe many different sensations, including unsteadiness, imbalance, clumsiness, light-headedness and vertigo. However, vertigo is a medical term referring to an illusion of movement, which may be subjective (personal perception of motion) or objective (observation of motion of the environment), and is characteristically associated with disorders of the vestibular system. Young children are often unable to describe these different perceptions, and thus any complaint of dizziness, instability or vertigo should be considered in the broad context of the “dizzy child” for diagnostic purposes.

The facial nerve contains a variety of different types of fibres including somatic sensory fibres, which carry sensation from the skin of the outer ear and its immediate vicinity, visceral sensory fibres, which carry taste from the anterior two-thirds of the tongue and from the palate, visceral motor fibres, which supply secretomotor function in the submandibular and sub-lingual salivary glands, and branchial motor fibres, which innervate the muscles of facial expression and the stapedius (Fig. 47.1). These latter fibres comprise the vast majority of the facial nerve fibres.